1225033145 NPI number — THE ORTHOPEDIC STORE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225033145 NPI number — THE ORTHOPEDIC STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ORTHOPEDIC STORE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225033145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792590
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78279-2590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-366-2990
Provider Business Mailing Address Fax Number:
210-499-4984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 ARION PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-366-2990
Provider Business Practice Location Address Fax Number:
210-499-4984
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARIG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
RANDOLPH
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
210-366-2990

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  643020000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1446635-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040GZ . This is a "BCBS OF TEXAS-PT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 643020000 . This is a "TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1446627-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com